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Stumpfe MC, Suffa N, Merkel P, Ludolph I, Arkudas A, Horch RE. Quick and safe: why a k-wire-extension-block-fixation of a bony mallet finger is the favoured treatment. Arch Orthop Trauma Surg 2024; 144:1437-1442. [PMID: 38147078 PMCID: PMC10896929 DOI: 10.1007/s00402-023-05119-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 10/28/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Mallet fingers are the most common tendon injuries of the hand. Bony avulsion distal finger extensor tendon ruptures causing a mallet finger require special attention and management. In this monocentral study, we analyzed the clinical and individual outcomes succeeding minimal invasive k-wire extension block treatment of bony mallet fingers. MATERIALS AND METHODS In a retrospective study, we sent a self-designed template and a QUICK-DASH score questionnaire to all patients, who were treated because of a bony mallet finger between 2009 and 2022 and fulfilled the inclusion criteria. A total of 244 requests were sent out. 72 (29.5%) patients participated in the study. Forty-five men and twenty-seven women were included. RESULTS 98.7% (n = 75) of the cases were successfully treated. Patients were highly satisfied with the treatment (median 8.0; SD ± 2.9; range 1.0-10.0). Based on the QUICK-DASH score, all patients showed no difficulties in daily life. The extent of avulsion did not influence the outcome. CONCLUSION We conclude that the minimally invasive treatment of a bony mallet finger should be offered to every patient, because it is safe, fast, and reliable. Thus, we propose to perform extension-block pinning independently of the articular area.
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Affiliation(s)
- Maximilian C Stumpfe
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Krankenhausstrasse 12, 91054, Erlangen, Germany.
| | - Nadine Suffa
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Pauline Merkel
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Ingo Ludolph
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Krankenhausstrasse 12, 91054, Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg FAU, Krankenhausstrasse 12, 91054, Erlangen, Germany
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Azad A, Kegel G, Phelps J, Marshall A, Lafer MP, Rocks M, Catalano L, Barron OA, Glickel S. A Prospective Analysis of Patient Characteristics Affecting the Outcome of Dorsal Splinting for Soft Tissue Mallet Injuries. Hand (N Y) 2023; 18:1330-1335. [PMID: 35611505 PMCID: PMC10617484 DOI: 10.1177/15589447221093674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Much has been written about the diagnosis and treatment of soft tissue mallet injuries. However, there has been little regarding the characteristics of this injury affecting patients' prognosis. The purpose of this prospective study was to identify factors influencing the outcome of treatment of soft tissue mallet injuries. METHODS Patients diagnosed with soft tissue mallet injuries were enrolled prospectively in a protocol of dorsal splinting for 6 to 12 weeks, followed by weaning over 2 weeks and then evaluated at 6, 9, and ≥12 months. RESULTS Thirty-seven patients (38 digits) completed the study. Treatment success was defined as a final extensor lag of <15° and failure as a final extensor lag of ≥15°. Those failing splint treatment were older compared with those successfully treated. Patient compliance was significantly associated with a successful outcome. Factors that did not significantly affect success included time to treatment, initial injury severity, splinting duration, sex, and ligamentous laxity. Disabilities of Arm, Shoulder, and Hand scores >0 were not associated with treatment failure. Radiographic and clinical extension lag were statistically comparable. CONCLUSIONS This study shows strong association between the success of splint treatment, younger patient age, and compliance with the treatment protocol. Despite this finding, most patients did not report any functional limitations, irrespective of the treatment success. In contrast to prior results, time to treatment and initial extensor lag did not significantly affect treatment success.
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Affiliation(s)
- Ali Azad
- Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, USA
| | - Gary Kegel
- Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, USA
| | - James Phelps
- Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, USA
| | - Astrid Marshall
- Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, USA
| | - Marissa P. Lafer
- Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, USA
| | - Madeline Rocks
- Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, USA
| | - Louis Catalano
- Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, USA
| | - O. Alton Barron
- Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, USA
| | - Steven Glickel
- Department of Orthopedic Surgery, NYU School of Medicine, NYU Langone Health, USA
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Peng C, Huang RW, Chen SH, Hsu CC, Lin CH, Lin YT, Lee CH. Comparative outcomes between surgical treatment and orthosis splint for mallet finger: a systematic review and meta-analysis. J Plast Surg Hand Surg 2023; 57:54-63. [PMID: 36625383 DOI: 10.1080/2000656x.2022.2164291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Mallet finger is a commonly encountered condition in daily practice. However, there is currently no consensus on whether surgical intervention or conservative treatment with orthosis splint is superior. In this systematic review and meta-analysis, we compare the treatment outcomes between surgery and orthosis for bony and tendinous mallet finger. We searched PubMed, Embase, and the Cochrane Library according to the PRISMA guidelines from inception to January 15, 2021. The primary outcome was distal interphalangeal (DIP) joint extension lag angle, and secondary outcomes were DIP joint flexion and range of motion (ROM) angle. A total of 297 studies were initially identified, of which 13 (ten retrospective non-randomized controlled studies (non-RCTs) and three RCTs) were included in the final analysis. The results of this systematic review and meta-analysis showed that there was no high level of evidence supporting the superiority of surgery over orthosis in the treatment of mallet finger. Based on the available evidence, surgical intervention and conservative treatment with splint may offer similar clinical outcomes in both bony and tendinous mallet finger.
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Affiliation(s)
- Chi Peng
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Ren-Wen Huang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Heng Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Chen Hsu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Te Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,International Master Science Program in Reconstructive Microsurgery, Chang Gung University, Taoyuan, Taiwan
| | - Che-Hsiung Lee
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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4
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Giddins G. Mallet Finger: Two Different Injuries. Hand Clin 2022; 38:281-288. [PMID: 35985751 DOI: 10.1016/j.hcl.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Mallet injuries, either tendinous or bony, are common. They are often studied together and typically treated in the same way with extension splintage for 6 to 8 weeks. Yet the evidence clearly shows there are different injuries that present in the same way. Tendinous mallet injuries present in older patients usually following a low energy injury; they are often painless. The commonly injured fingers are the middle and ring. The injuries are almost always single digit without concomitant injuries. There is an extensor lag of a mean of 310 (range 3°-590) in the patients treated in my unit. In contrast, bony mallet injuries occur at a younger age (mean 40 years) and are always due to high energy injuries. The injuries are always painful. The commonly injured fingers are the ring and little fingers. There are multiple injuries in 3% (range 2%-5%) and in 4% to 8% of cases, there are concomitant (nondigital) injuries according to data in my unit. Radiologically there is an appreciably smaller extensor lag; mean 130 (range 0°-400). In particular, bony mallet injuries are extension compression, not avulsion, fractures which should not logically be treated with an extension splint which will reproduce the direction of injury.
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Affiliation(s)
- Grey Giddins
- The Hand to Elbow Clinic, Bath, Bath, United Kingdom; Royal United Hospital, Bath, United Kingdom; University of Bath, Bath, United Kingdom.
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5
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Brush M, Dick NR, Rohman EM, Bohn DC. Comparison of Orthosis Management Failure Rates for Mallet Injuries. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:220-225. [PMID: 35880156 PMCID: PMC9308152 DOI: 10.1016/j.jhsg.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/05/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose A closed mallet injury is a common finger injury involving terminal extensor tendon avulsion from its insertion on the distal phalanx. Nonsurgical treatment with continuous extension orthosis fabrication is the preferred treatment. Our purpose was to report the failure rates of orthotic management by digit and investigate other factors that contribute to failure. Methods This was a retrospective chart review of all patients with an isolated mallet finger injury managed at our institution from 2011 to 2019. Patient demographics, details of management, and treatment outcomes were collected. Failure rates were compared for all digits, specifically comparing the little finger versus all other digits. A categorical variable analysis was performed to identify risk factors for failure of orthosis management. Results Out of 1,331 identified patients, 328 met the inclusion criteria. There was no statistically significant difference of failure rate between digits. There was a trend toward the little finger failing at a higher rate (n = 131, 40%) than the other digits individually (P = .08) and combined (n = 95, 29%; P = .06). An older age at injury was associated with failure. The median patient age with failure was 54 years, versus the median patient age with nonfailure of 48 years (P < .01). The failure rate was higher in tendinous versus bony mallet injuries (n = 131, 40% vs n = 66, 20%, respectively; P < .01). The orthotic type was associated with the failure rate, and failure was highest in patients treated with Stack orthoses (n = 183, 56%; P = .01). Conclusions There was no significant difference in the orthotic management failure rate by digit for a mallet injury. Statistically significant risk factors for failure are increasing age, a tendinous injury, and the orthotic type. Further evaluation with a larger cohort is warranted to increase the statistical power of the findings. Type of study/level of evidence Therapeutic III.
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Affiliation(s)
- Michael Brush
- University of Minnesota Medical School, Minneapolis, MN
| | | | - Eric M. Rohman
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - Deborah C. Bohn
- TRIA Orthopaedic Center, Bloomington, MN
- Corresponding Author: Deborah C. Bohn, MD, TRIA Orthopaedic Center, 8100 Northland Drive, Bloomington, MN 55431.
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7
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Suffa N, Merkel P, Horch RE, Arkudas A, Ludolph I, Stumpfe MC. [Temporarily Transfixation of the distal interphalangeal Joint in Mallet fingers]. HANDCHIR MIKROCHIR P 2021; 53:441-446. [PMID: 34583399 DOI: 10.1055/a-1551-3481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE This retrospective, unicenter cohort study analyse the clinical and subjective results following temporarily K-wire transfixation of the distal interphalangeal joint (DIPJ) in hyperextension in Mallet fingers. PATIENTS AND METHODS By means of a self-designed questionnaire demographic data, patient´s satisfaction (0 = unsatisfied, 10 = very satisfied), persisting pain (yes/no), postoperative complications, and the Quick-DASH score were evaluated. In addition, range of motion of the DIPJ was measured with use of a self-designed template for self-evaluation by the patients. Questionnaire and template were send to 132 patients in whom a Mallet finger was treated between January 2009 and December 2019 with K-wire transfixation of the DIPJ. 65 (49,2 %) questionnaires and templates from 40 men and 25 women with an average age of 53.3 years returned. There were 40 acute and 25 chronic Mallet fingers in 35 (54 %) middle, 19 (29 %) small, 10 (15 %) ring, and 1 (2 %) index fingers. The extension deficit was classified according to Crawford. RESULTS According to the Crawford classification, there were 75 % excellent, 14 % good, and 11 % satisfied results. With an average of 7,9 points the patients were very satisfied. 15 patients reported about complications with six complaining persisting pain. The Quick-DASH score averaged 5.4 points. CONCLUSION The treatment of Mallet fingers by transfixation of the DIPJ using a K-wire is an appropriate method leading to a good.
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Affiliation(s)
- Nadine Suffa
- Universitätsklinikum Erlangen, Plastische und Handchirurgische Klinik
| | - Pauline Merkel
- Universitätsklinikum Erlangen, Plastische und Handchirurgische Klinik
| | - Raymund E Horch
- Universitätsklinikum Erlangen, Plastische und Handchirurgische Klinik
| | - Andreas Arkudas
- Universitätsklinikum Erlangen, Plastische und Handchirurgische Klinik
| | - Ingo Ludolph
- Universitätsklinikum Erlangen, Plastische und Handchirurgische Klinik
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Bastien J, Rouzaud S. When should splint treatment start for a tendinous mallet finger? A retrospective review of 319 fingers. HAND SURGERY & REHABILITATION 2021; 40:491-494. [PMID: 33775888 DOI: 10.1016/j.hansur.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/20/2021] [Accepted: 01/23/2021] [Indexed: 11/25/2022]
Abstract
In a 5-year retrospective review of 319 tendinous mallet fingers, we focused on the result after splint treatment. The splint we used was a 'no pressure' thermoformed customized Stack splint. The patients wore it strictly for 8 weeks. Based on the Patel criteria, we obtained 91% good or excellent results and 9% fair or poor results. The rate of excellent results increased significantly (p < 0.001) when treatment started 20 days after the trauma. Patients were 13 times more likely to have good or excellent results with a delayed treatment. We noticed that inflammation in the distal interphalangeal joint seemed to be detrimental to the healing process. We suggest assessing if there is inflammation to anticipate the failure of treatment, which will lead to a longer treatment. Further studies on the subject should confirm this.
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Affiliation(s)
- J Bastien
- Department of Hand Surgery, Institut Aquitain de la Main, 56 Allée des Tulipes, 33600 Pessac, France
| | - S Rouzaud
- Department of Hand Surgery, Institut Aquitain de la Main, 56 Allée des Tulipes, 33600 Pessac, France.
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9
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Abstract
Acute tendon and bony injuries of the distal phalanx are challenging injuries because they may result in chronic pain, hypersensitivity, stiffness, and deformity if they are not adequately treated. Flexor tendon avulsions require early surgical repair. Conversely, most extensor tendon injuries and fractures heal well with nonoperative treatment. However, surgery is indicated in selected patients, and meticulous technique is required to achieve good postoperative outcomes. In this article, we outline the pertinent clinical anatomy of the distal phalanx, review the current literature regarding treatment options, and highlight key management points to ensure good clinical outcomes while minimizing complications.
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Affiliation(s)
- Janice C Y Liao
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, Singapore; Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Soumen Das De
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore.
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10
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Thillemann JK, Thillemann TM, Kristensen PK, Foldager-Jensen AD, Munk B. Splinting versus extension-block pinning of bony mallet finger: a randomized clinical trial. J Hand Surg Eur Vol 2020; 45:574-581. [PMID: 32338190 DOI: 10.1177/1753193420917567] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Surgical treatment of bony mallet fingers is frequently recommended, but the evidence is sparse. This randomized clinical trial aimed to compare nonoperative splinting versus extension-block pinning of bony mallet fingers with involvement of more than one-third of the joint surface but without primary joint subluxation. Thirty-two patients were randomized and 28 fulfilled the protocol. At 6 months follow-up, there were no significant differences in active extension lag in the distal interphalangeal joint (the primary outcome) or in patient-reported function and pain scores. Flexion and active range of motion in the distal interphalangeal joint and finger-to-palm distance were better in the splinting group, but three patients developed secondary subluxation. We conclude from this study, that splinting these injuries is safe and efficient in restoring joint motion, but splinting does not sufficiently prevent secondary subluxation of the joint. Radiographic follow-up during splinting appears to be necessary. Level of evidence: I.
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Affiliation(s)
- Janni K Thillemann
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark.,Department of Orthopaedics, University Clinic of Hand, Hip and Knee Surgery, Holstebro, Denmark
| | | | - Pia K Kristensen
- Department of Orthopaedic Surgery, Regional Hospital Horsens, Horsens, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Bo Munk
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
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Batıbay SG, Akgül T, Bayram S, Ayık Ö, Durmaz H. Conservative management equally effective to new suture anchor technique for acute mallet finger deformity: A prospective randomized clinical trial. J Hand Ther 2019; 31:429-436. [PMID: 28966061 DOI: 10.1016/j.jht.2017.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Prospective randomized controlled trial. PURPOSE OF THE STUDY This study was designed to compare our new suture anchor technique with conservative management in acute Wehbe-Schneider type I A-B and II A-B mallet fingers. METHODS Twenty nine patients who presented to our clinic between 2013 and 2015 were randomized for surgical or conservative treatment. Wehbe-Schneider subtype C fractures were excluded. Fourteen were treated with surgery, and 15 were treated with conservative treatment. Primary outcomes were visual analog scale score, active distal interphalangeal (DIP) joint flexion, return to work, extension deficit and DIP joint degeneration. Follow-up time was 12 months. RESULTS The mean visual analog scale was 2.0, and return to work was on average in 63.2 days in the surgical group and 1.47 and 53.7 days in the conservative group. Extension deficit was 8.1° in the surgical group and 6.1° in the conservative group. The mean DIP flexion at final follow-up was 54.5° (40-65) in the surgery group and 58.3° (45-70) in the conservative group. DIP joint degeneration was observed with X-rays in 4 patients in surgical group, and none of the patients in the conservative group had DIP degeneration at 1 year after treatment. CONCLUSIONS The therapeutic effectiveness of suture anchor technique was not statistically different from conservative treatment. Subluxation seen after fixation treatment with suture anchors may be due to inadequate anchor fixation. DIP joint degeneration was seen significantly more in the surgical group. Our study suggests that the new suture anchor technique is not superior to conservative treatment. LEVEL OF EVIDENCE Ib.
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Affiliation(s)
- Sefa Giray Batıbay
- Department of Orthopedics and Trauma, Umraniye Education and Research Hospital, İstanbul, Turkey
| | - Turgut Akgül
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, İstanbul, Turkey
| | - Serkan Bayram
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, İstanbul, Turkey.
| | - Ömer Ayık
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, İstanbul, Turkey
| | - Hayati Durmaz
- Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul University, İstanbul, Turkey
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12
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Mallet Finger as a Complication of Dermatologic Surgery: Diagnosis, Treatment, and Prevention. Dermatol Surg 2019; 45:997-999. [DOI: 10.1097/dss.0000000000001710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Suture and Splint Compared With K-Wire Fixation for Open Zone 1 Extensor Tendon Injuries. Ann Plast Surg 2018; 81:176-177. [DOI: 10.1097/sap.0000000000001394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Lin JS, Samora JB. Surgical and Nonsurgical Management of Mallet Finger: A Systematic Review. J Hand Surg Am 2018; 43:146-163.e2. [PMID: 29174096 DOI: 10.1016/j.jhsa.2017.10.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 09/18/2017] [Accepted: 10/03/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The current literature describes multiple surgical and nonsurgical techniques for the management of mallet finger injuries, and there is no consensus on the indications for surgical treatment. The objective of this study was to determine, through a literature review, if any conclusions can be drawn concerning the indications for surgery in mallet finger injuries; the treatment outcomes of surgical versus nonsurgical management; the most effective methods of surgical and nonsurgical treatment; and the most common treatment complications of mallet finger injuries. METHODS A systematic review of multiple databases was performed. English language clinical studies evaluating therapeutic interventions for mallet fingers that reported objective, standardized outcome measures were included. Basic science studies, cadaveric studies, conference abstracts, level V evidence studies, studies lacking statistical data, and tendinous injuries other than mallet fingers were excluded. Salvage procedures and studies evaluating exclusively chronic lesions were also excluded. RESULTS Forty-four studies that reported clinical outcomes for the treatment of mallet finger injuries, 22 evaluating surgical treatments and 17 studies investigating nonsurgical treatments were included. The average distal interphalangeal joint extensor lag was 5.7° after surgical treatment and 7.6° after nonsurgical treatment. Complication rates of surgical and nonsurgical interventions were comparable (14.5% and 12.8%, respectively). Five studies directly compared the outcomes of surgical with nonsurgical management, with mixed results and recommendations. CONCLUSIONS Both surgical and nonsurgical treatments of mallet finger injuries lead to excellent clinical outcomes. Insufficient evidence is available to determine when surgical intervention is indicated. Based on our literature review, it appears that these treatments are equivalent and should be individualized to the patient. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- James S Lin
- The Ohio State University College of Medicine, Columbus, OH
| | - Julie Balch Samora
- The Ohio State University College of Medicine, Columbus, OH; Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, OH.
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Saito K, Kihara H. A randomized controlled trial of the effect of 2-step orthosis treatment for a mallet finger of tendinous origin. J Hand Ther 2017; 29:433-439. [PMID: 27769840 DOI: 10.1016/j.jht.2016.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 06/30/2016] [Accepted: 07/12/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A randomized clinical trial, with patients treated either by new 2-step orthosis or by the figure-eight-type orthosis with the distal interphalangeal (DIP) joint extended. PURPOSE OF THE STUDY To report on our new orthosis and to evaluate the treatment efficacy of using a 2-step orthosis for the treatment of a mallet finger of tendinous origin compared with a conventional orthosis. METHODS Forty-four patients were randomized into the 2-step or conventional orthosis groups. Primary outcomes were active DIP joint flexion and extensor lag, pain, and the Abouna-Brown criteria. RESULTS The 2-step orthosis was associated with a smaller active DIP extensor lag, compared with the conventional orthosis (-7.5 ± 4.5° vs -16.4 ± 6.9°, P = .001), combined with a significantly higher Abouna-Brown criteria (χ2 = 14.57, P = .01). No other between-group differences were identified. CONCLUSION The therapeutic effectiveness of the 2-step orthosis, over a conventional orthosis, was supported by a large effect size of the treatment in improving residual active extensor lag at the DIP and overall Abouna-Brown criteria. Our study thus suggested that the initial immobilization involved in new 2-step orthosis and is thus a good immobilization technique. LEVEL OF EVIDENCE Ib.
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Affiliation(s)
- Kazuo Saito
- Department of Rehabilitation Center, Fuchinobe General Hospital, Sagamihara, Kanagawa, Japan.
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16
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Warren RA, Norris SH, Ferguson DG. Mallet Finger: A Trial of Two Splints. JOURNAL OF HAND SURGERY 2017; 13:151-3. [PMID: 3385289 DOI: 10.1016/0266-7681_88_90124-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Over a period of twelve months, 116 cases of mallet finger were allocated randomly to treatment with either a Stack or Abouna splint. The two splints were equally effective, producing a cure or a significant improvement in approximately 50% of cases. However, the Stack splint was much preferred by the patients, who found it more comfortable, more robust and easier to keep clean.
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17
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Richards SD, Kumar G, Booth S, Naqui SZ, Murali SR. A Model for the Conservative Management of Mallet Finger. ACTA ACUST UNITED AC 2017; 29:61-3. [PMID: 14734074 DOI: 10.1016/s0266-7681(03)00220-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This prospective study assessed the results of a custom-made thermoplastic splint for treatment of mallet finger deformity. From April 1999 to April 2000, 42 patients with mallet finger deformity were recruited. All patients were seen within 1 week and treated with a thermoplastic splint custom made by the hand therapy department. The splint was simple to make, easy to fit and suitable for all finger shapes and sizes. It improved the deformity in 30 out of 34 cases, and caused no skin irritation.
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Affiliation(s)
- S D Richards
- Department of Orthopaedics, Royal Albert Edward Infirmary, Wigan, UK
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Cook S, Daniels N, Woodbridge S. How do hand therapists conservatively manage acute, closed mallet finger? A survey of members of the British Association of Hand Therapists. HAND THERAPY 2016. [DOI: 10.1177/1758998316664822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Previous research concerning the conservative management of mallet finger has focused on splint application, with limited representation of supplementary rehabilitation and best practice. This research sought to investigate the practice and opinions of members of the British Association of Hand Therapists regarding their current treatment and to determine whether any specific exercise prescription or rehabilitation protocols are followed. Methods British Association of Hand Therapists members were contacted via e-mail and requested to complete an online survey. Thirty-five responses (5.7% response rate), 30 (4.8% response rate) of which were fully completed were obtained over the eight-week data collection period. The questionnaire consisted of 30 questions (20 quantitative and 10 qualitative) concerning therapists’ roles and condition management. Responses were analysed in terms of response frequencies, percentages and thematic text analysis. Results The results demonstrated current clinical practices in line with available best-evidenced practice. Conservative therapeutic management is diverse and varied. Therapists believe their role to be significant in optimising outcome success. Discussion Exercises and other interventions supplementary to splinting are commonly utilised in the therapeutic management of acute, closed mallet finger. This research found hand therapists implement a diverse range of clinical skills in order to optimise outcome success. Recommendations for best practice and further research are presented.
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Affiliation(s)
- Samantha Cook
- Physiotherapy Department, Barnsley Hospital, Barnsley, UK
| | - Nikki Daniels
- College of Health and Social Care, University of Derby, Derby, UK
| | - Sarah Woodbridge
- College of Health and Social Care, University of Derby, Derby, UK
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Conservative treatment of mallet finger: A systematic review. J Hand Ther 2016; 28:237-45; quiz 246. [PMID: 26003015 DOI: 10.1016/j.jht.2015.03.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 02/28/2015] [Accepted: 03/03/2015] [Indexed: 02/03/2023]
Abstract
PURPOSE To determine if there is a superior orthosis and wearing regimen for the conservative treatment of mallet finger injuries. The secondary purpose is to examine the current evidence to evaluate if a night orthosis is necessary following the initial immobilization phase. METHODS A comprehensive literature search was conducted using the search terms mallet finger, splint, orthosis, and conservative treatment. RESULTS Four randomized controlled trials (RCTs) were included in the systematic review. In all 4 RCTs mallet fingers were immobilized continuously for 6 weeks in acute injuries and 8 weeks for chronic injuries. CONCLUSIONS Two of the three studies found a large effect size for orthotic intervention ranging from 2.17 to 12.12. Increased edema and age and decreased patient adherence seem to negatively influence DIP extension gains. Recommended immobilization duration is between 6 to 8 weeks and with additional weeks of immobilization in cases of persistent lags. LEVEL OF EVIDENCE 1a.
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Review of Acute Traumatic Closed Mallet Finger Injuries in Adults. Arch Plast Surg 2016; 43:134-44. [PMID: 27019806 PMCID: PMC4807168 DOI: 10.5999/aps.2016.43.2.134] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 02/23/2016] [Accepted: 02/24/2016] [Indexed: 12/16/2022] Open
Abstract
In adults, mallet finger is a traumatic zone I lesion of the extensor tendon with either tendon rupture or bony avulsion at the base of the distal phalanx. High-energy mechanisms of injury generally occur in young men, whereas lower energy mechanisms are observed in elderly women. The mechanism of injury is an axial load applied to a straight digit tip, which is then followed by passive extreme distal interphalangeal joint (DIPJ) hyperextension or hyperflexion. Mallet finger is diagnosed clinically, but an X-ray should always be performed. Tubiana's classification takes into account the size of the bony articular fragment and DIPJ subluxation. We propose to stage subluxated fractures as stage III if the subluxation is reducible with a splint and as stage IV if not. Left untreated, mallet finger becomes chronic and leads to a swan-neck deformity and DIPJ osteoarthritis. The goal of treatment is to restore active DIPJ extension. The results of a six- to eight-week conservative course of treatment with a DIPJ splint in slight hyperextension for tendon lesions or straight for bony avulsions depends on patient compliance. Surgical treatments vary in terms of the approach, the reduction technique, and the means of fixation. The risks involved are stiffness, septic arthritis, and osteoarthritis. Given the lack of consensus regarding indications for treatment, we propose to treat all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger, which we treat with extra-articular pinning.
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Kim JY, Lee SH. Factors Related to Distal Interphalangeal Joint Extension Loss After Extension Block Pinning of Mallet Finger Fractures. J Hand Surg Am 2016; 41:414-9. [PMID: 26794127 DOI: 10.1016/j.jhsa.2015.11.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/20/2015] [Accepted: 11/20/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify factors related to postoperative extension loss when treating mallet finger fractures with extension block pinning. METHODS We reviewed 31 consecutive patients with a mallet finger fracture treated with extension block pinning. We measured range of motion of the distal interphalangeal (DIP) joint including extension lag. We investigated the injury mechanism and checked radiographic factors such as DIP joint subluxation, fixation angle, fragment size index, fracture angle, and amount of articular involvement. We performed statistical analyses such as correlation analysis, multiple regression analysis, and independent t test to investigate factors related to postoperative extension loss. RESULTS Mean voluntary extension loss at final follow-up was 5° (range, 0° to 20°) and mean active flexion of the DIP joint was 84° (range, 75° to 90°). Sixteen patients had a forceful flexion injury and 15 had a simple blow injury. Fixation angle was not associated with postoperative extension loss. Postoperative extension loss increased significantly in the forceful flexion group compared with that in the simple blow injury group. Fragment size index, fracture angle, and amount of articular involvement decreased significantly in the forceful flexion group compared with that in the simple blow injury group and were negatively linearly correlated with postoperative extension loss. Multiple regression analysis showed that sex and injury mechanism affected postoperative extension loss. CONCLUSIONS Sex, injury mechanism, fragment size index, fracture angle, and amount of articular involvement should be considered to anticipate postoperative extension loss even though mallet finger fractures were successfully reduced and healed using extension block pinning. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- Jin Young Kim
- Department of Orthopedic Surgery, Dongguk University College of Medicine, Goyang, Korea.
| | - Sung Hyun Lee
- Department of Orthopedic Surgery, Dongguk University College of Medicine, Goyang, Korea
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Witherow EJ, Peiris CL. Custom-Made Finger Orthoses Have Fewer Skin Complications Than Prefabricated Finger Orthoses in the Management of Mallet Injury: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2015; 96:1913-1923.e1. [PMID: 26163944 DOI: 10.1016/j.apmr.2015.04.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 04/16/2015] [Accepted: 04/16/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate which orthosis results in (1) fewer complications; (2) the least extensor lag; and (3) the highest rates of treatment success according to the Abouna and Brown criteria for soft tissue mallet injury in adults. DATA SOURCES Electronic databases AMED, CINAHL, Embase, MEDLINE, PubMed, OTseeker, and PEDro were searched from the earliest available date until September 16, 2014. STUDY SELECTION Controlled trials evaluating orthosis type in the conservative management of mallet injury were included. Database searching yielded 1024 potential studies, of which 7 met inclusion criteria with a total of 491 participants. DATA EXTRACTION Data were extracted using an author-designed extraction form by one reviewer, and accuracy was assessed by a second reviewer. The PEDro scale was used to assess methodological quality. DATA SYNTHESIS Results were pooled using a random-effects model with inverse variance methods. Dichotomous outcomes are expressed as risk ratios (RRs) and 95% confidence intervals (CIs) and continuous outcomes as standardized mean differences and 95% CIs. There is moderate quality evidence that prefabricated orthoses had 3 times the risk of developing skin complications as compared with all other orthoses (RR, 3.17; 95% CI, 1.19-8.43; I(2)=47%) and nearly 7 times the risk of developing skin complications as compared with custom-made thermoplastic orthoses (RR, 6.72; 95% CI, 1.59-28.46; I(2)=0%). Treatment outcomes were found to be similar for treatment success when prefabricated orthoses were compared with custom-made orthoses (RR, .99; 95% CI, 0.80-1.22; I(2)=39%; very low quality evidence), as well as for extensor lag when custom-made thermoplastic orthoses were compared with other orthoses (standardized mean difference, .03; 95% CI, -.29 to .36; I(2)=0%; moderate quality evidence). CONCLUSIONS Prefabricated orthoses were found to increase the risk of developing skin complications as compared with custom-made orthoses, but there were no differences in treatment success, failure, or extensor lag.
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Affiliation(s)
| | - Casey L Peiris
- Northern Health, Epping, Victoria, Australia; La Trobe University and Northern Health, Melbourne, Victoria, Australia
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Abstract
Treatment goals for the management of extensor tendon injuries include restoration of function, minimizing disability, and decreasing the risk of complications. These goals can be achieved with an accurate understanding of the zone-specific concerns for extensor tendon injuries, early referral to hand therapy, and active communication between hand surgeons and therapists. This article reviews extensor tendon injuries by zone, outlines optimal management strategies that help prevent complications, and describes the treatment of these complications.
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Affiliation(s)
- Kristina Lutz
- Division of Plastic Surgery, Department of Surgery, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, Room D1-204, 268 Grosvenor Street, London, Ontario N6A 4L6, Canada
| | - Joey Pipicelli
- Division of Hand Therapy, Faculty of Rehabilitation Sciences, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, Room D3-148, 268 Grosvenor Street, London, Ontario N6A 4L6, Canada
| | - Ruby Grewal
- Division of Orthopedic Surgery, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, 268 Grosvenor Street, London, Ontario N6A 4L6, Canada.
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McCarten G. Extensor tendon injuries. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Altan E, Alp NB, Baser R, Yalçın L. Soft-Tissue Mallet Injuries: A Comparison of Early and Delayed Treatment. J Hand Surg Am 2014; 39:1982-5. [PMID: 25194772 DOI: 10.1016/j.jhsa.2014.06.140] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 06/27/2014] [Accepted: 06/27/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the results of early and delayed extension orthosis fabrication in closed tendinous mallet injuries. METHODS Between March 1992 and May 2011, 45 patients with isolated closed tendinous mallet finger injuries were treated with orthosis fabrication. The patients were classified into 2 different groups based on their date of presentation. Group 1 consisted of 28 patients who presented within 2 weeks of sustaining the trauma, and group 2 consisted of 17 patients who received treatment beginning between 2 and 4 weeks after sustaining the trauma. During the final assessments, the patients were assessed clinically using the Crawford classification scale and satisfaction ratings. RESULTS The mean delay between initial injury and presentation to our center was 3 days (range, 1-14 d) in group 1 and 19 days (range, 15-30 d) in group 2. There were no significant differences between the groups regarding their ages, initial extension lag, and arc of flexion. According to the Crawford classification criteria, 72% of the patients in group 1 had excellent results, and 59% of the patients in group 2 had excellent results. There was no significant difference between the groups. CONCLUSIONS The treatment results of patients with different presentation times have been reported for heterogeneous groups of osseous and nonosseous mallet finger injuries. Our results suggest that conservative management of tendinous mallet finger injuries that have been neglected for 2 to 4 weeks can be treated as well as those injuries in patients presenting within the first 2 weeks of injury with low long-term complication rates. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- Egemen Altan
- Orthopaedics and Traumatology Department, Selcuk University, Konya, Turkey; Orthopaedics and Traumatology Department, Agri State Hospital, Agri, Turkey; Manus Hand Surgery Center, Istanbul, Turkey; Orthopaedics and Traumatology Department, Istanbul Bilim University, Manus Hand Surgery Center, Istanbul, Turkey
| | - Nazmi Bulent Alp
- Orthopaedics and Traumatology Department, Selcuk University, Konya, Turkey; Orthopaedics and Traumatology Department, Agri State Hospital, Agri, Turkey; Manus Hand Surgery Center, Istanbul, Turkey; Orthopaedics and Traumatology Department, Istanbul Bilim University, Manus Hand Surgery Center, Istanbul, Turkey
| | - Reyhan Baser
- Orthopaedics and Traumatology Department, Selcuk University, Konya, Turkey; Orthopaedics and Traumatology Department, Agri State Hospital, Agri, Turkey; Manus Hand Surgery Center, Istanbul, Turkey; Orthopaedics and Traumatology Department, Istanbul Bilim University, Manus Hand Surgery Center, Istanbul, Turkey
| | - Levent Yalçın
- Orthopaedics and Traumatology Department, Selcuk University, Konya, Turkey; Orthopaedics and Traumatology Department, Agri State Hospital, Agri, Turkey; Manus Hand Surgery Center, Istanbul, Turkey; Orthopaedics and Traumatology Department, Istanbul Bilim University, Manus Hand Surgery Center, Istanbul, Turkey.
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Xie R, Tang J, Wang G, Liu G. Passive correction of Mallet deformity with a MicrofixQuickanchor Plus: a cadaveric study. J Plast Reconstr Aesthet Surg 2014; 67:e171-2. [PMID: 24703515 DOI: 10.1016/j.bjps.2014.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 02/06/2014] [Accepted: 03/08/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Renguo Xie
- Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu 226001, China.
| | - Jinbo Tang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu 226001, China
| | - Guheng Wang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu 226001, China
| | - Guofeng Liu
- Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu 226001, China
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Tocco S, Boccolari P, Landi A, Leonelli C, Mercanti C, Pogliacomi F, Sartini S, Zingarello L, Nedelec B. Effectiveness of cast immobilization in comparison to the gold-standard self-removal orthotic intervention for closed mallet fingers: a randomized clinical trial. J Hand Ther 2014; 26:191-200; quiz 201. [PMID: 23453367 DOI: 10.1016/j.jht.2013.01.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 01/05/2013] [Accepted: 01/21/2013] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Randomized clinical trial. INTRODUCTION Although orthotic immobilization has become the preferable treatment choice for closed mallet injuries, it is unclear whether orthosis self-removal has an impact on the final outcome. PURPOSE To evaluate the treatment efficacy of cast immobilization of closed mallet fingers using Quickcast(®) (QC) compared to a removable, lever-type thermoplastic orthosis (LTTP). METHODS 57 subjects were randomized in 2 groups. DIPj extensor lag and the Gaberman success scale were used as primary outcomes. RESULTS LTTP subjects resulted in greater extensor lag than QC subjects (x = 5°; p = 0.05) at 12 weeks from baseline, and high edema and older age negatively affected DIPj extensor lag. No other differences were found between groups. CONCLUSION Cast immobilization seems to be slightly more effective than the traditional approach probably for its greater capacity to reduce edema. LEVEL OF EVIDENCE 1B.
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Affiliation(s)
- Silvio Tocco
- Studio Terapico Kaiser, Via Trento 15/A, 43100 Parma, Italy.
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Kakinoki R, Ohta S, Noguchi T, Kaizawa Y, Itoh H, Duncan SF, Matsuda S. A MODIFIED TENSION BAND WIRING TECHNIQUE FOR TREATMENT OF THE BONY MALLET FINGER. ACTA ACUST UNITED AC 2013; 18:235-42. [DOI: 10.1142/s0218810413500299] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purpose: To report the outcomes of mallet fractures treated with our modified tension band wiring technique. Methods: Eleven men and two women (mean age; 33 years) with mallet fractures in which happened more than five weeks before surgery, or with fracture fragments involving more than 2/3 or less than 1/3 of the distal phalanx articular surface or with previous surgical intervention, were subjected to this study. The fracture fragment was fixed with a modified tension band wiring technique using a stainless steel wire and an injection needle. Results: All patients achieved bone union in nine weeks in average. All patients had no pain except one with mild pain. No patient showed a gap or step-off greater than 1 mm. Conclusions: Our tension band wiring technique can be used regardless of the size of the dorsal fracture fragment or the interval between injury and surgery.
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Affiliation(s)
- Ryosuke Kakinoki
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8570, Japan
- Department of Rehabilitation Medicine, Kyoto University Hospital, Kyoto 606-8570, Japan
| | - Soichi Ohta
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8570, Japan
| | - Takashi Noguchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8570, Japan
| | - Yukitoshi Kaizawa
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8570, Japan
| | - Hiromu Itoh
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8570, Japan
| | - Scott F. Duncan
- Department of Orthopedic Surgery, Ochsner Health System, Central, LA 70818, USA
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8570, Japan
- Department of Rehabilitation Medicine, Kyoto University Hospital, Kyoto 606-8570, Japan
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Kanaya K, Wada T, Yamashita T. The Thompson procedure for chronic mallet finger deformity. J Hand Surg Am 2013; 38:1295-300. [PMID: 23790421 DOI: 10.1016/j.jhsa.2013.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 04/11/2013] [Accepted: 04/11/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the outcomes of the Thompson procedure for chronic mallet finger deformity and review the utility of this procedure. METHODS Seven cases of chronic mallet finger with a swan neck deformity were treated by the Thompson procedure. Ranges of motion for the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints were measured, and complications were investigated at the final examination. Patients were evaluated using the criteria reported by Abouna and Brown. RESULTS Four patients were men, and 3 were women. The average age at the time of surgery was 44 years (range, 25 to 71 y). The middle finger was affected in 4 cases, and the index, ring, and small finger were involved in 1 case each. The average extensor lag on the DIP joint was 42° (range, 35° to 50°). All cases were treated with the Thompson procedure. The swan neck deformity was corrected in all cases. The average motion at the final examination was -4° (range, -30° to 0°) in extension and 91° (range, 85° to 110°) in flexion for the PIP joint and -5° (range, -10° to 0 °) in extension and 63° (range, 45° to 85°) in flexion for the DIP joint. A buttonhole deformity and a dimple at the proximal tied end of the graft were seen in 1 case. Assessment by the criteria of Abouna and Brown revealed that 6 of 7 patients were categorized as cured and one as improved. No patient was categorized as unchanged. CONCLUSIONS The procedure provides a predictable method for correcting loss of DIP joint extension with or without PIP joint hyperextension. We believe that the Thompson procedure is an effective technique for the salvage, following failed treatment, of a closed mallet injury with an associated swan neck deformity.
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Affiliation(s)
- Kohei Kanaya
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
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Abstract
Injuries to the finger extensor apparatus are very common and may produce chronic deformity and loss of function. Diagnosis is contingent on an understanding of the complex anatomy of this region as well as the ability to perform a careful physical examination. Immobilization is usually the most effective treatment of acute problems. Surgery is often necessary for chronic conditions, but the results are much less predictably corrective.
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Georgescu AV, Capota IMV, Matei IRG. A new surgical treatment for mallet finger deformity: deepithelialised pedicled skin flap technique. Injury 2013; 44:351-5. [PMID: 23340235 DOI: 10.1016/j.injury.2013.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Mallet finger, well-known also as drop finger or baseball finger, is a frequent deformity after extensor tendons injury in the fingers. Although numerous nonoperative or operative techniques have been used in managing this deformity, the treatment still remains a debated subject. PATIENTS AND METHODS Starting from 1996, 121 fingers in 118 patients with neglected deformity or unsuccessful splinting older than 10 days underwent surgical treatment. In 101 patients a tendinous mallet finger was present, and in 20 patients a bony mallet finger. After immobilising the distal interphalangeal (DIP) joint at 0° extension with a Kirschner wire, the extensor tendon was repaired by using a dorsal deepithelialised skin flap reinserted transosseous. The DIP joint was immobilised for 6 weeks in a thermoplastic splint, and after that it was gradually weaned from the immobilisation. An overnight splint was used for 4-6 weeks after starting the mobilisation. RESULTS The mean follow-up period was 10 months (range: 3-120 months). An excellent result in 89 fingers and a good result in 32 fingers were obtained, according to Crawford's evaluation criteria. CONCLUSION This method seems to be a new reliable alternative in the treatment of chronic mallet finger.
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Affiliation(s)
- Alexandru V Georgescu
- Plastic Surgery Reconstructive Microsurgery Clinic, University of Medicine and Pharmacy, Rehabilitation Hospital, Viilor St., No. 46-50, 400347, Cluj Napoca, Romania
| | - Irina M V Capota
- Plastic Surgery Reconstructive Microsurgery Clinic, University of Medicine and Pharmacy, Rehabilitation Hospital, Viilor St., No. 46-50, 400347, Cluj Napoca, Romania
| | - Ileana R G Matei
- Plastic Surgery Reconstructive Microsurgery Clinic, University of Medicine and Pharmacy, Rehabilitation Hospital, Viilor St., No. 46-50, 400347, Cluj Napoca, Romania.
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Abstract
Mallet finger is a common injury involving either an extensor tendon rupture at its insertion or an avulsion fracture involving the insertion of the terminal extensor tendon. It is usually caused by a forceful blow to the tip of the finger causing sudden flexion or a hyperextension injury. Fracture at the dorsal aspect of the base of the distal phalanx is commonly associated with palmar subluxation of the distal phalanx. Most mallet finger injuries are recommended to be treated with immobilisation of the distal interphalangeal joint in extension by splints. There is no consensus on the type of splint and the duration of use. Most studies have shown comparable results with different splints. Surgical fixation is still indicated in certain conditions such as open injuries, avulsion fracture involving at least one third of the articular surface with or without palmar subluxation of the distal phalanx and also failed splinting treatment.
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Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Boris Fung
- Department of Orthopaedics and Traumatology, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Wing Yuk Ip
- Department of Orthopaedics and Traumatology, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
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Minchin P, Spirtos M. Investigation of the conservative management of mallet injury in Irish acute hospitals. HAND THERAPY 2012. [DOI: 10.1258/ht.2012.012004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Mallet injury is a commonly treated hand injury in acute hospitals. While there is much literature regarding the various treatment options and outcomes, no studies were found that describe the management of this injury across a national health service. This study describes how mallet injury is managed within the acute hospital system in Ireland. An understanding of the current system of service provision is essential for future service development in this area. Method Emergency and occupational therapy departments in the 29 acute case-mix hospitals in Ireland were contacted by telephone and postal questionnaire with 47 respondents participating in the study. Descriptive statistics are used to present the results. Results Results indicate that accessing acute hospital-based services for the conservative management of mallet injury typically follows a predictable pathway, but can result in delays and disruption to treatment for the patient. There is little evidence of direct referral from the emergency department to the occupational therapist which, when compared with published literature, would represent the most efficient and optimum care pathway for the patient. The choice of splint used by both the emergency and occupational therapy departments differs, but treatment provided is in line with available evidence-based practice. Conclusions This preliminary study provides a basis for future service development in the acute management of mallet injury, by describing how treatment is currently provided nationally. Recommendations for further investigation have been made, and the need for audit and outcome measurement has been highlighted. The development of therapy-led services in Ireland is proposed, to improve efficiency and quality of service provision in the conservative management of mallet injury.
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Affiliation(s)
- Paula Minchin
- Occupational Therapy Department, Adelaide & Meath Hospital, Dublin, Ireland
| | - Michelle Spirtos
- Discipline of Occupational Therapy, Trinity College, Dublin, Ireland
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Griffin M, Hindocha S, Jordan D, Saleh M, Khan W. Management of extensor tendon injuries. Open Orthop J 2012; 6:36-42. [PMID: 22431949 PMCID: PMC3293224 DOI: 10.2174/1874325001206010036] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 10/22/2011] [Accepted: 10/27/2011] [Indexed: 11/24/2022] Open
Abstract
Extensor tendon injuries are very common injuries, which inappropriately treated can cause severe lasting impairment for the patient. Assessment and management of flexor tendon injuries has been widely reviewed, unlike extensor injuries. It is clear from the literature that extensor tendon repair should be undertaken immediately but the exact approach depends on the extensor zone. Zone I injuries otherwise known as mallet injuries are often closed and treated with immobilisaton and conservative management where possible. Zone II injuries are again conservatively managed with splinting. Closed Zone III or ‘boutonniere’ injuries are managed conservatively unless there is evidence of displaced avulsion fractures at the base of the middle phalanx, axial and lateral instability of the PIPJ associated with loss of active or passive extension of the joint or failed non-operative treatment. Open zone III injuries are often treated surgically unless splinting enable the tendons to come together. Zone V injuries, are human bites until proven otherwise requires primary tendon repair after irrigation. Zone VI injuries are close to the thin paratendon and thin subcutaneous tissue which strong core type sutures and then splinting should be placed in extension for 4-6 weeks. Complete lacerations to zone IV and VII involve surgical primary repair followed by 6 weeks of splinting in extension. Zone VIII require multiple figure of eight sutures to repair the muscle bellies and static immobilisation of the wrist in 45 degrees of extension. To date there is little literature documenting the quality of repairing extensor tendon injuries however loss of flexion due to extensor tendon shortening, loss of flexion and extension resulting from adhesions and weakened grip can occur after surgery. This review aims to provide a systematic examination method for assessing extensor injuries, presentation and management of all type of extensor tendon injuries as well as guidance on mobilisation pre and post surgery.
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Affiliation(s)
- M Griffin
- Academic Foundation Trainee, Kingston Upon Thames, London, UK
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O'Brien LJ, Bailey MJ. Single Blind, Prospective, Randomized Controlled Trial Comparing Dorsal Aluminum and Custom Thermoplastic Splints to Stack Splint for Acute Mallet Finger. Arch Phys Med Rehabil 2011; 92:191-8. [DOI: 10.1016/j.apmr.2010.10.035] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 09/08/2010] [Accepted: 10/26/2010] [Indexed: 11/15/2022]
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Abstract
BACKGROUND Mallet finger is a common injury. The aim of this review is to give an overview of the different treatment options of mallet injuries and their indications, outcomes, and potential complications. METHODS A literature-based study was conducted using the PubMed database comprising world literature from January of 1980 until January of 2010. The following search terms were used: "mallet" and "finger." RESULTS There are many variations in the design of splints; there are, however, only a few studies that compare the type of splints with one another. Splinting appears to be effective in uncomplicated and complicated cases. Equal results have been reported for early and delayed splinting therapy. To internally fixate a mallet finger, many different techniques have been reported; however, none of these studies examined their comparisons in a controlled setting. In chronic mallet injuries, a tenodermodesis followed by splinting or a tenotomy of the central slip is usually performed. If pain and impairment persist despite previous surgical corrective attempts, an arthrodesis of the distal interphalangeal joint should be performed. CONCLUSIONS Uncomplicated cases of mallet injuries are best treated by splinting therapy; cases that do not react to splinting therapy are best treated by surgical interventions. Controversy remains about whether mallet injuries with a larger dislocated bone fragment are best treated by surgery or by external splinting.
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Pike J, Mulpuri K, Metzger M, Ng G, Wells N, Goetz T. Blinded, prospective, randomized clinical trial comparing volar, dorsal, and custom thermoplastic splinting in treatment of acute mallet finger. J Hand Surg Am 2010; 35:580-8. [PMID: 20353859 DOI: 10.1016/j.jhsa.2010.01.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 01/02/2010] [Accepted: 01/07/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare volar, dorsal, and custom splinting techniques in acute Doyle I mallet finger injuries. METHODS We developed a radiographic lag measurement using the contralateral normal digit as an internal control for establishing the approximate preinjury maximal extension of the mallet finger. The difference in maximal distal interphalangeal joint extension between the injured and contralateral normal digit was defined as the radiographic lag difference. We randomized 87 subjects meeting the inclusion criteria to one of 3 splint types: volar padded aluminum splint, dorsal padded aluminum splint, and custom thermoplastic. Splints were continued for 6 weeks full-time. A total of 77 subjects were available for measurement of the primary outcome measure: radiographic lag difference at week 12. Secondary outcome measures were recorded at weeks 7 and 24. RESULTS No lag difference was demonstrated at week 12 (p = .12), although a trend suggesting superiority (closest value to 0 difference) of the custom thermoplastic splint was observed. The mean radiographic lag differences were -16.2 degrees (95% confidence interval [CI], -21.3 degrees to -11.0 degrees ) for the dorsal padded aluminum splint, -13.6 degrees (95% CI, -18.0 degrees to -9.2 degrees ) for the volar padded aluminum splint, and -9.0 degrees (95% CI, -14.5 degrees to 3.4 degrees ) for the custom thermoplastic splint. Secondary between-group analyses showed no differences for radiographic or clinical lag, Michigan Hand Outcome Questionnaire scores, or complications. Secondary analyses of the whole cohort suggested that clinical measurement overestimates true lag, increased lag occurs after discontinuation of splinting, and clinically measured improvement in lag is noted at week 24. CONCLUSIONS No lag difference was demonstrated between custom thermoplastic, dorsal padded aluminum splint, and volar padded aluminum splinting for Doyle I acute mallet fingers. Clinical measurement overestimates true lag in mallet injuries. Increased lag occurs after discontinuation of splinting. Increased age and complications correlate with worse radiographic lag.
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Affiliation(s)
- Jeffrey Pike
- Department of Orthopaedics, Washington School of Medicine, St. Louis, MO, USA
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Man C, Branford O, Schreuder F. A tale of two mallet injuries. J Plast Reconstr Aesthet Surg 2009; 62:e587-8. [DOI: 10.1016/j.bjps.2008.11.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Revised: 11/23/2008] [Accepted: 11/25/2008] [Indexed: 11/26/2022]
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Closed mallet thumb injury: a review of the literature and case study of the use of magnetic resonance imaging in deciding treatment. Plast Reconstr Surg 2009; 124:222-226. [PMID: 19568085 DOI: 10.1097/prs.0b013e3181ab1172] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY At present, the literature dedicated to closed mallet thumb injury offers conflicting evidence between conservative and operative approaches. Although conservative treatment is often successful, retraction of the extensor pollicis tendon may lead to improper reattachment and continued deformity. This discussion and case report serve to highlight the use of magnetic resonance imaging as an adjunct in selecting the proper treatment strategy for this injury at initial presentation.
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White N, Khanna A. Clinical audit of the impact of information leaflets on outcomes in patients with mallet finger injuries. J Plast Reconstr Aesthet Surg 2007; 60:1369-70. [PMID: 17544351 DOI: 10.1016/j.bjps.2007.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2006] [Revised: 11/09/2006] [Accepted: 04/20/2007] [Indexed: 11/28/2022]
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Starcević B, Bumbasirević M, Lesić A, Radonjić V, Mirić D. [The results of surgical and nonsurgical treatment of mallet finger]. SRP ARK CELOK LEK 2007; 134:521-5. [PMID: 17304767 DOI: 10.2298/sarh0612521s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The injury of the hand tendon classified as mallet finger presents the loss of continuity of the united lateral band of the extensor apparatus above distal interphalangeal joint, which consequently leads to specific deformity of distal interphalangeal joint which is called mallet (hammer) finger. OBJECTIVE Our paper had several research objectives: presentation of the existing results of surgical and nonsurgical treatment of mallet finger deformities and comparison of our findings and other authors' results. METHOD The study was retro-prospective, and analyzed 62 patients treated in the Clinical Center of Serbia in Belgrade (at the Institute of Orthopedic Surgery and Traumatology, and the Emergency Center) in the period 1998 to 2003. The follow up of these patients lasted at least 8 months (from 8.3 months to 71.7 months). An average follow up was 28.7 months. The objective parameters used in the study were as follows: sex, age, dominating hand, hand injury, finger injury, mode of treatment, complications, distal interphalangeal joint flexion and total movement of the distal interphalangeal joint. Collected data were analyzed by chi2-test and Student's t-test. The confidence interval was p = 0.05. RESULTS A total range of motion was 51.9 +/- 6.6 for nonsurgically treated patients, and 48.2 +/- 4.2 degrees for operated patients. Mean extension deficit of the distal interphalangeal joint was 6.5 +/- 3.3 for nonsurgical and 10.0 +/- 3.2 for operated patients. CONCLUSION The results confirmed that nonsurgical mode of treatment of mallet finger deformity was much more successful than surgical method of treating the same deformity.
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Teoh LC, Lee JYL. Mallet fractures: a novel approach to internal fixation using a hook plate. J Hand Surg Eur Vol 2007; 32:24-30. [PMID: 17134796 DOI: 10.1016/j.jhsb.2006.09.007] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Revised: 08/27/2006] [Accepted: 09/05/2006] [Indexed: 02/03/2023]
Abstract
A new treatment of mallet fractures of the distal phalanx is presented. Open reduction and internal fixation was performed using a "hook" plate fabricated from a 1.3 mm AO hand modular system straight plate. This technique avoids the need to place implants or wires through the small avulsion fragment while still being able to achieve a stable "tension-plate" type of fixation construct strong enough to allow protected early active motion of the distal interphalangeal joint. In minimising the need for prolonged splinting, patient comfort is also improved. In a consecutive series of nine fractures, union was achieved in all cases. At an average follow-up period of 17 months, four had excellent and five had good results using the Crawford rating scale. Using the Warren and Norris scale, all patients had a successful result. The final average active range of flexion of the distal interphalangeal joint was 64 degrees and there was no extensor lag.
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Affiliation(s)
- L C Teoh
- Department of Hand Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
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Kalainov DM, Hoepfner PE, Hartigan BJ, Carroll C, Genuario J. Nonsurgical treatment of closed mallet finger fractures. J Hand Surg Am 2005; 30:580-6. [PMID: 15925171 DOI: 10.1016/j.jhsa.2005.02.010] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Revised: 02/16/2005] [Accepted: 02/16/2005] [Indexed: 02/02/2023]
Abstract
PURPOSE Surgical repair of closed mallet finger fractures has been favored for displaced injuries involving more than one third of the articular surface and for injuries with palmar subluxation of the distal phalanx. This study analyzed the results of nonsurgical treatment for closed and displaced mallet finger fractures with greater than one-third articular surface damage, comparing cases with and without concomitant terminal joint subluxation. METHODS Twenty-two closed mallet finger fractures in 21 patients who were treated nonsurgically and involving more than one third of the articular surface were reviewed retrospectively. The patients were treated by continuous extension splinting of the distal interphalangeal joint for a mean of 5.5 weeks. The average patient age at the time of injury was 35.2 years, with a mean delay to treatment of 21 days. Nine cases showed a reduced distal interphalangeal joint at presentation (type IB) and 13 cases showed palmar subluxation of the distal phalanx (type IIB). Complications from splinting were limited to 2 cases of transient skin irritation. All patients returned for new finger radiographs and completed a survey to assess pain, function, and satisfaction at an average of 24.5 months after injury. RESULTS Patients expressed negligible pain, minimal difficulties with activities of daily living and work, relatively high satisfaction with finger function and treatment outcome, but only marginal satisfaction with finger appearance. The differences between type IB and type IIB cases were not significant. The resultant terminal joint extensor lag improved in both groups. Moderate and large joint prominences, swan-neck deformities, and moderate arthritis were seen more commonly in type IIB cases but the differences between groups were not significant. CONCLUSIONS This study supports the rationale for nonsurgical treatment of closed and displaced mallet finger fractures with greater than one-third articular surface involvement. Pain likely will be negligible and patient satisfaction with finger function and treatment outcome is projected to be relatively high at 2-year follow-up evaluation. A dorsal joint prominence, terminal joint extensor lag, swan-neck deformity, and degenerative joint changes, however, may develop, particularly in cases with palmar subluxation of the distal phalanx.
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Affiliation(s)
- David M Kalainov
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Hart RG, Kleinert HE, Lyons K. The Kleinert modified dorsal finger splint for mallet finger fracture. Am J Emerg Med 2005; 23:145-8. [PMID: 15765333 DOI: 10.1016/j.ajem.2004.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Injuries to the hand and digits are commonly seen in the emergency department. Lacerations, contusions, puncture wounds, and fractures comprise the bulk of these injuries. A fracture to the dorsum of the distal phalanx can result in a mallet finger deformity. These fractures must be accurately diagnosed with the proper initial treatment begun. There is some disagreement over the best treatment approach and multiple different splints have been described in the literature. Conservative treatment with a finger splint is most commonly effective. We recommend a modified dorsal finger splint for these injuries. We describe a splint to properly treat the fracture, prevent complications, maximize patient comfort during rehabilitation, and prevent mallet finger deformity.
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Affiliation(s)
- Raymond G Hart
- Department of Emergency Medicine, University of Louisville School of Medicine, KY 40202, USA.
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Handoll H, Vaghela M. Re: A model for the conservative management of mallet finger. Richards et al. Journal of Hand Surgery, 2004, 29B: 61-63. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 2004; 29:411; author reply 411-2. [PMID: 15234512 DOI: 10.1016/j.jhsb.2004.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Abstract
BACKGROUND Mallet finger, also called drop or baseball finger, is where the end of a finger cannot be actively straightened out due to injury of the extensor tendon mechanism. Treatment commonly involves splintage of the finger for six or more weeks. Less frequently, surgical fixation is used to correct the deformity. OBJECTIVES To examine the evidence for the relative effectiveness of different methods of treating mallet finger injuries. SEARCH STRATEGY We searched the Cochrane Musculoskeletal Injuries Group trials register (November 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2004), MEDLINE (1966 to February week 2 2004), EMBASE (1988 to 2004 week 8), other databases, reference lists of articles and various conference proceedings. SELECTION CRITERIA Randomised or quasi-randomised clinical trials evaluating different interventions, including no intervention, for treating mallet finger injuries. DATA COLLECTION AND ANALYSIS Two reviewers independently performed study selection, quality assessment and data extraction. Study authors were contacted for additional information. MAIN RESULTS Four trials were included. These involved a total of 278, mainly adult, participants with 283 mallet finger injuries. All four trials were methodologically flawed, including inadequate outcome assessment. Three trials compared different types of finger splints versus a standard Stack splint. One trial found a lower incidence of treatment failure in participants treated with a perforated custom-made splint. One trial found there were fewer complications in participants treated with a padded aluminium-alloy malleable finger splint; however, the incidence of treatment failure was similar in the two treatment groups. One trial evaluating the Abouna splint found a similar incidence of treatment failure in the two groups. However, the Abouna splint often needed replacing due to disintegration of its rubber cover and rusting of the exposed wires and was also less popular with participants. The fourth trial found no statistically significant differences between participants whose mallet finger was treated with Kirschner wire fixation and those with a Pryor and Howard splint. Similar numbers had complications in the two groups. REVIEWERS' CONCLUSIONS There was insufficient evidence from comparisons tested within randomised trials to establish the relative effectiveness of different, either custom-made or off-the-shelf, finger splints used for treating mallet finger injury. There was a useful reminder that splints used for prolonged immobilisation should be robust enough for everyday use, and of the central importance of patient adherence to instructions for splint use. There was insufficient evidence to determine when surgery is indicated.
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Rettig AC. Athletic injuries of the wrist and hand: part II: overuse injuries of the wrist and traumatic injuries to the hand. Am J Sports Med 2004; 32:262-73. [PMID: 14754754 DOI: 10.1177/0363546503261422] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Hand and wrist injuries in sports are some of the most common injuries reported. This review discusses common overuse injuries of the wrist including tendon injuries such as de Quervain's syndrome, subluxation of the extensor carpi ulnaris, and the common dorsal carpal impingement syndrome. The main focus of this section is the discussion of traumatic injuries to the hand in the athlete. Included is a discussion and review of fractures of the phalanges and metacarpals, common proximal interphalangeal joint injuries, and thumb carpal metacarpal and metacarpophalangeal joint injuries. Emphasis is placed on more common injuries seen regarding diagnosis, indications for non-operative versus operative treatment, and time to return to athletic competition.
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Abstract
PURPOSE The purpose of this report is to review the results of displaced mallet fractures treated with an extension block pin and transarticular fixation of the distal interphalangeal joint. METHODS We retrospectively reviewed 23 patients with 24 fractures to determine the results of treatment, time to union, range of motion, and associated complications. RESULTS The average patient age was 24 years and the average fracture size was 40% of the joint surface. Ten patients were treated acutely (less than 10 days), 10 subacutely (10-30 days), and 3 chronically (greater than 30 days). Average time to fracture union was 35 days. At 1-year or greater follow-up evaluation the average extension loss was 4 degrees and the average flexion was 77 degrees. There were no major complications and there were 5 minor complications. Using the established outcome criteria for mallet injuries, 92% had excellent or good results. CONCLUSIONS The results of this study showed that this surgical technique resulted in rapid fracture union with only minor complications and has excellent functional outcome based on established criteria.
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Affiliation(s)
- Eric P Hofmeister
- Division of Hand Surgery, Department of Orthopedics, Naval Medical Center, San Diego, CA, USA
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